Hurricane Katrina and the treatment crisis

In New Orleans, Hurricane Katrina decimated the city’s psychiatric services.

In the 16 months since the storm hit, the number of hospital beds has plummeted. Remaining facilities have limited space and people in crisis often end up being treated by – or held in – the city’s emergency rooms until a bed opens up somewhere else. And as for police, “two officers always escort psychiatric patients to emergency rooms, where they often must wait for hours until the hospital can accept them. The wait prevents officers from patrolling.”

Some small measure of relief may be coming in the form of a new psychiatric facility.

"That would be tremendous," [Dr. Joseph ] Guarisco [chairman of emergency medicine at Ochsner Medical Center] said. "Psych is our No. 1 crisis right now in the emergency department. The city's outpatient and inpatient psych capacity was plundered by the storm. We have been inundated with chronic mental illness without any available resources for these patients."

The country overall is facing very similar problems. Just because it took 40 years to reach this crisis nationwide doesn’t mean it isn’t worth addressing just as aggressively.

Our national system was plundered by a different kind of storm, waged not by nature, but by well-meaning advocates who saw all hospitals as negative and all commitment laws as paternalistic.

Sad story from Minnesota

Shortly after Stephen R. Miles was arrested for the slaying of his stepmother last December, attention focused on the family's unsuccessful attempts to hospitalize him just hours before the grisly killing in Burnsville. But parents Roland and Carol Miles struggled for years to get help for their 23-year old son, especially in the days and months before Maris Jo Miles died, recently filed court documents show. As the parents, social workers and doctors became concerned about Miles' worsening condition last year, each of them was powerless by themselves to force treatment on an adult who refused to take anti-psychotic medications. "The system is designed so that you have to fail first," said Sue Hanson, a mental health advocate and mother of a schizophrenic son. " And then you have to continue to be ill in order to receive help."

Miles is accused of decapitating his stepmother. Read the chilling transcript of his emergency room visit before the murder ...

USA Today: “Stuck in a vicious revolving door …”

"Dad, how would you feel if someone you loved killed himself?"

My college-age son, Mike, has stopped taking medication for the mental illness that was diagnosed a year ago, and he is having a relapse. He and I are speeding to an emergency room. Hang on son, I think. The doctors will help you.

But after waiting four hours, a doctor appears and tells me it's illegal to treat Mike. He is not sick enough. He is not in "imminent danger," and because Mike now thinks "pills are poison," the doctor cannot forcibly medicate him under Virginia law. I'm told to bring him back if he tries to kill himself or someone else.

MORE: Riveting new book on fighting for treatment - NPR: Fighting for treatment

Untreated mental illnesses compromise ALL emergency room patients

The general public has a vested interest in supporting psychiatric treatment mechanisms that stop the revolving door for people with severe mental illnesses.

A recent survey in Maryland confirms earlier reports that untreated mental illnesses compromise care for all patients needing emergency room care.

Maryland hospitals said these numbers are increasing, and 63 percent report increasing wait times for psychiatric patients — nearly double the wait time for other patients. The two major reasons for the long waits are a lack of available state mental health beds and outpatient/community resources for uninsured psychiatric patients.

According to a survey reported in 2004, more than 60 percent of emergency department physicians reported seeing an increase in patients presenting with psychiatric emergencies in the past 6-12 months. Emergency physicians attributed the rise in psychiatric patients to increasing state health care budget cutbacks and the decreasing number of psychiatric beds.

These increases have negative effects for all patients seeking emergency room care: reducing the availability of beds in the emergency department (96%), reducing the availability of emergency staff for other patients (91%), resulting in patient frustration (89%), resulting in longer waits for patients in the waiting room (85%) and increasing the amount of time the hospital diverts ambulances to other hospitals (31%).

Untreated mental illnesses affect everyone.